| NPI | 1417268731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 28051) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 8983) |
| 1223G0001X Dentist, General Practice (Licence: LA 6118) | |
| 1223G0001X Dentist, General Practice (Licence: TX 28051) | |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2022-10-04 |